Kahnawake is a Kanien'keha:ka (Mohawk) community of 7200 people (in year 2002) located 15 kilometres south west of Montreal, Canada. The Kahnawake Schools Diabetes Prevention Project (KSDPP) began in 1994 with NHRDP funding and continues today with CIHR funding for the KSDPP Center for Research & Training.

For KSDPP the long-term goal is to decrease the incidence of Type 2 diabetes through the short-term goals of increasing physical activity and healthy eating. Additional objectives are to incorporate Mohawk traditions and culture, promote community capacity building and program ownership. KSDPP is a participatory research project where the community and researchers are in partnership, each with their own expertise. The community is represented through a Community Advisory Board, and the partnership guidelines are outlined in the KSDPP Code of Research Ethics.

Evaluation of KSDPP includes changes in the elementary school children in Grades 1-6 for knowledge, perceived parental support, anthropometric measurements, eating patterns, physical activity, TV watching and fitness. Evaluation has also followed process changes in the schools and community, researched the evolution of the project itself and the community ownership of the project. Another project (CDA funded) has developed and validated a CD-ROM to evaluate physical activity interactive recall for children in grades 4-6. In addition a youth empowerment project (CDA funded) for those aged 14-18 years seeks to better understand youth perceptions of lifestyle and diabetes and to encourage youth to become role models for diabetes prevention.

The goals for the KSDPP Center for Research & Training funded by CIHR for 2001-2006 are to (a) complete 10 year evaluation of the KSDPP project in Kahnawake, (b) evaluate how the KSDPP project is disseminated and adapted throughout a network of Aboriginal communities in Canada, (c) offer academic training to masters, PhD and postdoctoral students interested in diabetes prevention, and (d) offer training to Aboriginal community researchers.

1. Set up a healthy eating environment. Take time out of your schedule to eat a nutritious meal without disturbances. Get friends and family together at meal times. Eat slowly and chew thoroughly without rushing. Individuals who consume meals in front of the television or while surfing the internet tend to overeat. Turn off your phone, which could lead you to mindless eating.

2. Incorporate your healthy eating plan into your social activities. Food tends to play a large role when socializing, but you don't have to sacrifice healthy food just to hang out with friends. Bring healthy food to gatherings and plan activities that feature healthy food. Instead of throwing a barbecue that features meat high in saturated fat and slathered with processed sauces, grill seafood and vegetables instead. Host healthy potlucks featuring homemade guacamole, baked salmon, whole-wheat pasta salad and homemade vegetable soups, for example.

3. Surround yourself with friends and family who are also following a healthy eating plan. It is difficult to incorporate your healthy eating plan into your lifestyle when the people around you engage in junk food love affairs. If you do not have friends and family that eat healthily, join a local group in your area. The internet is saturated with groups that focus on helping you meet other people in your area who also want to follow a healthy diet and lifestyle.

4. Engage in activities where food is not the primary focus. People use food as a way to celebrate, fend off boredom, soothe an aching heart and socialize. When your lifestyle revolves around food, it is harder to stick to your healthy eating plan. Go hiking on the weekends instead of grabbing margaritas and a high-calorie lunch with the girls. Pick up a hobby like painting, biking or crafts. Try gardening and grow some of your own nutritious vegetables and herbs.

5. Make cooking a part of your daily life. The best way to control the ingredients in your food and stick to your healthy eating plan is to prepare your own meals. Try to avoid slaving over the stove alone. Take cooking classes with a friend or your significant other so that you can make cooking fun and engaging. Set up stimulating ways to think about healthy cooking. For example, you can challenge your friends to create 200-calorie snacks. Then have a tasting of all snacks and have everyone vote on which one is best.

Diabetes with older people and eldersback to topAccepting and Coping with Diabetes

"It is believed that the impact is generally less severe than among younger people because older adults are more likely to accept a chronic illness such as diabetes as a natural part of the aging process" - Haire Joshu: 1996 :785

Older people experience the greatest number of health problems and complications related to diabetes but they have the least amount of social and emotional support.

Elders with diabetes may require more assistance from health workers and family members in coping and managing their conditions.

The Emotional Effects of Diabetes By Dr. Sanjay Guptaback to topManaging Diabetes From Morning to Night

Quiz: Which Has More Carbs?For people with type 2 diabetes, managing their emotional health can be as important as keeping their blood sugar under control. The condition requires constant attention, and that can trigger feelings of stress and anxiety. Studies have shown that diabetics are much more likely to have an anxiety disorder or depression. They may neglect their diet, stop monitoring glucose levels, or revert to unhealthy habits.

Steve Sternlof, PhD, a psychologist with the Harold Hamm Diabetes Center at the University of Oklahoma, talks about the psychological impact type 2 diabetes can have and ways to help patients cope.

How do you know if a diabetes patient is suffering from stress or anxiety?

There are different situations. It might be someone who is not compliant with their self-care and isn't checking their blood sugar regularly or taking their medications as prescribed. Their doctor notices this and sees their A1C [hemoglobin test] levels are up and there are problems. In that case we might get communication from their physician, and we'll help them work through their issues and come up with a game plan.

It might be a patient who is severely depressed and openly talking about their level of sadness and that they've given up hope. Their diabetes is affecting them socially and putting a strain on their relationships or marriage.

Sometimes patients are good at hiding these feelings. It's important that doctors ask questions and probe beyond how their medical care is going. A lot of patients are reluctant to talk about their feelings unless asked. When a doctor is willing to ask questions above and beyond whether or not they're checking their blood sugar, the patient is more willing to talk.

What are some of the major mental health issues that affect diabetics?

There's a high correlation between diabetes and depression. It can come in different forms and different levels of severity. Some people just get down a few days out of the week or month, others have chronic depression. It can be difficult for them just to get out of bed and function in their daily lives.

It can also create anxiety in that people worry about how they're going to talk about their disease to other people, and whether or not they'll understand what they have to go through.

They also worry about how diabetes will affect how long they live, they worry about complications, whether or not they'll go blind, if they'll need a limb amputated. It creates a lot of stress and worry. Even if their diabetes is under control, it's that "what if" factor.

Diabetes also has a big effect on interpersonal relationships. People who have these depression or anxiety problems and have a chronic illness tend to withdraw from others and isolate themselves. The problem is a lot of depressed patients put loved ones off. I tell family members to not give up-the patient may not respond after the first or fifth time, but maybe after the twentieth time. They at least have to leave the door open.

How do you help someone diagnosed with diabetes cope with the pressures of constant self-care?

It's a big struggle. People live their lives and have a certain way of living it and have certain habits and routines. Those things are very hard to break. When you get diagnosed with diabetes, you don't have to totally break them. But now you have to fit in something else throughout the day every day for the rest of your life. This involves checking your blood sugar, taking your medication, watching what you eat, doing some kind of physical activity, following up with your doctor.

Some people decide their diabetes care either doesn't fit into their routine or it falls short on their priority list. Most people will list their job and their family and other things way above diabetes care on their priority list.

I usually have new patients reflect on why diabetes care is such a low priority when it involves taking care of their health and quality of life and how long they'll live well with the disease. It's helpful when they can make that connection on their own that if they don't take care of themselves and don't manage the disease properly, then they're not going to be around to have a job or spend time with their family.

Does there need to be more of a focus on mental health in caring for people with diabetes?

When the emphasis is just on the physical - that my body isn't performing the way that it should - that's difficult for some people. It's helping to change their thinking and have them realize that while they may not have control over the way their body uses insulin, they can at least control how they feel about it. Everyday life, even without diabetes, is tough enough. When you add diabetes that requires so much of someone every single day, it creates an extra burden of stress. Sometimes people don't feel like they have an avenue of escape. It's important they have something they can find joy or comfort in.